HomeMy WebLinkAbout4536 Seaway Cir - Applications/Reroof - 09/09/20145EP-09-2014 16:37 From: advancedexter hors
To:19702246134 Pa9e:10,'14
Fort Collins
WEIR.1 ul
planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO a0s24
Phone 970-416_2740 Fax 224-6134
E"COUNTER PERM ' /®C9a
This application is to be used to a ONLY'
80
• Damon IOn (interior nan-structu apply for the following permits onl
❑ Heating Unit ❑ ►sq ❑ Electrical Alteration not sere Y (check all that apply). O Air Conditioning
Lawn Sprinkler a Mobile Home replacement e ohan98) U Gas righter p Gag Lo
0 Ventilation � Water Heater p Water Line ❑ Roofin 9 _
manufacturer). WoodlPellet Stove (must be pq certified, providewer Line makePhoto-vol�ic
Complete all e0 cable information on the application.
Application #
� ofice ose on/y
Job Site Address (required)
Prop" Owner Name
Applicant Name
Contractor
model and
Incomplete applications will n t be accepted,
Date
Value of CanstruCtion (labor, materials, profit)
$ e-,fl,_
Address City/state
Address �ty/ate
uc #Ielt ( $ Address
Contractor City of Ft. Collins sales Tax #
s0AM tar
Conbadphm
Oty/State
Cott�ws Zip 'rc'�;2S PhoneL7
ZIP .. Phone
Are you paying taxes he a or by report? M Here ❑ Report
Are You paying with your trot account? 4 Yes I* No
Is this a residential orcon�y�lrrtteerfdal project? Residential Q Commercial
If residential, is it: ENIngle Family Detached El Condo/townhome (single family attached
If commercial, is it: d Ban13 ks a K(apartment)
rp p Church p Hotel/motelg) ❑Duplex
0 Restaurant p C] Medical office O Office ❑ Retail
Other (explain)
Is this building SO years of age or morel p Yes 4 No If yes, You may need to contact N/sh nrC Prvmvadon
If this t5 for a damolitlan perrrrit, what year oo
was the building rrstructed?
Ifpnor 1975, you w/// need an s�9 assumnent to submit with this app/icaDon.
Desrriptfon of work
*If lawn sprinkler/1)MMOw y
Rre�enter, must list licensed p mber. If first-time A/C, must list licensed
Suhccnb actors; Lac the Company name or City of Cv///its /kit- e #
lReMdan Plumper
MeethaNeal__� Roofer iL
✓h Other
I hereby admowledge that I have read this application and state that the above informa
comply w'dh ail requirementg contained herein and city ordinances and state laws
bon is complete and correct i agree to
permit Is not valid until it has been paid and issued, regulating building construction. Z know that a
Applicant:
Print Name: �jlsignature
Date T/ 9l IV